Q Are there any alternative treatments for polymyalgia rheumatica? I have had it since having a hip replacement. - LK, Ridgewood, New Jersey
A Polymyalgia rheumatica (PMR) is a debilitating condition in which the small blood vessels that supply the muscles that support the body - those of the neck and shoulders, and hips and thighs - become inflamed. PMR has been recognised as a disease only since 1969, and its symptoms are non-specific and include stiffness and aches.
This arthritis-like condition is usually treated with steroids. So, given the fact that steroids are such powerful drugs, it makes sense to try a less aggressive method first.
High on the WDDTY list of general recommendations would be to eliminate coffee and tea, and other products containing caffeine. Often, PMR patients have an excess of calcium in relation to magnesium so, in addition to cutting out cow's milk products, they would also need to take magnesium supplements.
Candida may also be involved as well as food intolerance and low stomach acid. The opinion of many members of WDDTY's panel, including Dr Melvyn Werbach, is that a multifactorial approach that includes diet as well as homoeopathy (BMJ, 1989; 299: 365-6), massage (Scand Rheum J, 1986; 15: 174-8), electroacupuncture (BMJ, 1992; 305: 1249-52), hypnotherapy (J Rheum, 1991; 18: 72-5), osteopathy, auricular therapy, biofeedback and transcutaneous electrical nerve stimulation (TENS) may be the best way of getting on top of this unpleasant condition.
Gentle exercises such as yoga can relieve pain and improve joint function (J Rheumatol, 1994; 21: 2341-3), and tai chi may be more effective than the usual forms of exercise (Am J Occup Ther, 1987; 41: 90-5).
Increase your intake of B vitamins. Both B5 (pantothenic acid) and B3 (niacinamide) have proved beneficial at doses of 25 mg/ day. These should be taken in the form of a balanced B-complex supplement and should not be taken at night. Niacinamide reduces inflammation and increases joint flexibility (Inflam Res, 1996; 45: 330-4).
Native Americans valued black cohosh and used it for a range of conditions. Some 19th-century American physicians used the herb for arthritis (PROOF! vol 7 no 12, Product Review).
Increase your intake of healthy oils. Omega-3 fatty acids can reduce morning stiffness (J Rheumatol, 1992; 19: 1531-6) as can a diet high in polyunsaturated fat and low in saturated fat (Ann Rheum Dis, 2003; 62: 208-14; Lancet, 1985; i: 184-7). Blackcurrant seed oil, rich in gamma-linolenic acid (GLA) and alpha-linolenic acid (ALA), can ease inflammation (Br J Rheumatol, 1994; 33: 847-52). So can fish oil, though you'd need to take several capsules of essential fatty acid (EFA) supplements daily to derive any benefit.
Another alternative is green-lipped mussel extract (Allerg Immunol [Paris], 2000; 32: 272-8), which is not only rich in EFAs, but is also reputed to contain the powerful anti-inflammatory eicosatetraenoic acid (ETA).
Although most doctors don't question the cause of PMR, you should consider the possible contribution of your replacement hip. There have been instances of metallic debris from the materials used in hip replacement surgery 'travelling' to distant parts of the body. Also, French doctors question the safety of some of the materials involved, including titanium and polyethylene, after they found that metallic debris had travelled to a patient's spleen and liver eight years after surgery, causing weight loss and fatigue (N Engl J Med, 1996; 335: 133).
This kind of environmental insult is well known to cause autoimmune conditions. If this is the problem, short of having another operation, you may be able to remove the metallic debris from your body with chelation therapy. This can be done with either well-known chelators like DMSA (dimercaptosuccinic acid), used to remove mercury from the mouth, or you can take continual supplements like MSM (methylsulphonylmethane) and NAC (N-acetylcysteine), which can help mercury toxicity. These all chemically grab metals in your bloodstream and excrete them from your body.
If you elect to use chelation therapy with DMSA, you will need the help of a qualified practitioner. With MSM and NAC, you may take them over three to six months at one dose initially (two capsules three times a day), then come down to a regular dosage once a day.
Another area to explore is food allergy. Dr Chris Reading in Australia has theorised that most of our illnesses stem from an inherited 'autoimmune pattern' mainly triggered by an 'allergy' to the components of common foods.
The biggest culprits are usually grains, milk, eggs, beef and yeast. As the foods most often linked with autoimmune problems are grains, you could first try coming off wheat to see if your condition improves. If your joints are also affected, you might also try eliminating nightshades (potatoes, tomatoes, aubergines and peppers).